A couple of weeks ago I had my elderly parents over for lunch. The subject of flu vaccination came up. My father is dead set against this practice and views flu as a largely self-limiting illness that rarely leads to significant complication. He’s right.
My mother, on the other hand, has dutifully attended her doctor’s clinic for the last few years for her flu shot. Vaccination is, by her own admission, always followed by a persistent cough. This may be coincidence, of course, or perhaps a nocebo response (like a placebo response, only negative).
I suggested she might rethink her views on the vaccination, especially in light of evidence published in the British Medical Journal in September 2008 and in February 2010 in The Cochrane Library that suggests that the flu shot does not particularly help the elderly (as it’s so often said to do). The upshot is my mom skipped her flu shot this year.
Another reason why I’m not particularly enthusiastic about flu vaccination is that the evidence base for it appears pretty flimsy. In November 2008, the British Medical Journal published a review of the literature. From reading the BMJ article, you may come to the conclusion that flu vaccination policy is based on misreporting and misrepresentation of the actual evidence.I started to think about this topic again on receipt of an e-mail yesterday from a U.S.-based doctor who alerted me to a document titled “Healthcare Workers Must Be Vaccinated Against Influenza.” It is written by Dr. Eric Kasowski, a doctor in the Center for Disease Control’s (CDC’s) Influenza Division. It urges health care workers to get their flu shots.
Oddly, for something aimed at health professionals, it cites no studies. I don’t want to be overly suspicious, but this is usually not a good sign.
While we health professionals like to think of ourselves as independently minded people, we are as subject to groupthink as anyone else. Do doctors really have time to go back to the original research, read it, and assess it? Not usually. Normally, we doctors will accept what our governments tell us quite uncritically.
A month or so ago, I was listening to the radio and the subject of flu vaccination. The issue of the evidence for this practice came up. The doctor in the radio studio was not only unable to cite any evidence but also stated that there MUST be evidence, otherwise our government would not be advising that we have these shots.
I’d like to say that such naivety is a rare thing in medicine, but my experience tells me that it is not.
After talking with my parents, I thought I’d take a look for any more-recent evidence relevant to flu vaccination and came across a review published in July 2010 by the Cochrane Collaboration (a collective of international doctors and scientists supposedly dedicated to objective assessments of treatments by proper review of the evidence). The authors of this review highlight the fact that industry-funded studies were more likely to report positive findings and be published in prestigious journals and be cited more frequently.
One of the problems with flu vaccination is that it tends not to work if the strains of flu in the vaccine do not match the strains of flu in the environment. Even when the match is perfect, 1 percent of flu-vaccinated individuals end up with an infection, compared to 4 percent of unvaccinated individuals.
However, in partial matching of vaccine-infecting strains, which is usually how things are, these figures are 1 percent and 2 percent respectively. In other words, the true reduction in flu risk in the population is a mere 1 percent.
Beware when governments and the doctors and scientists paid by them urge us to do things but do not cite appropriate evidence (as is the case with the recent missive from Dr. Kosowski).
These folks may put forth a case that seems like a no-brainer. What is often going on is that they’re hoping that individuals will not look at the evidence base, engage their brains, and think for themselves.
Dr. John Briffa is a London-based physician and author with an interest in nutrition and natural medicine. His website is Drbriffa.com